HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:: d'� �/ � Permit Number•.---1-�-«
RECEIVEc-
Buildift Permit Applicati®n FEB -9 2016
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMITAPPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION'-.L-
Address:
OCATION ,Address: 63 C cc f/e qr 6
Legal'De crip ion: 510,:Fn(EA
Property Tax ID : 61—-5 60'—6Lot No. /W
Site Plan Name: 1 L e s CoViAVL4 Cltlb Block No.
Project Name: V 67
Setbacks Front Back: Right Side: Left Side:
DETAILED.DESCRIPTION.OFWORK -
I Frd A, pez
CONSTRUCTION:INFORMATION:
A( ttiona workto e e rme under tis permit-c e a appy.
1 1HVAC Gas Tank Gas Piping _Shutters _ F�Windows/Doors
DElectric Plumbing Sprinklers FIGenerator ® Roof
Total Sq.Ft of Construction: o"Z S .Ft.of First Floor:
Cost of Construction:$ ��, Utilities: Sewer Septic Building Height:
OWNER/LESSEE CONTRACTOR: -
Name Name: � �(� C
Address a -S Company: K i lac-
City: c eGT� State Address: E f E f_C✓
Zip Cade:,Dl/' lc(5 Fax: City: F f 1 i= r�� State:
Phone No. tv 7 2-0 �Zip Code:J ,F U ,>- Fax:
E-Mail: Phone No.
Fill in fee simple isle Holder on next page(if different E-Mail: K oAceP Pr UfcY4 2(,Qaf
from the Owner listed above) State or Coun License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
5upP E�Etii1'A►i_ OINS t �N �:S i Alii INF_ "10ft,.
®ESI NWENGINEEi: Not Avolicahle R40RTGAGE COMP: Not Asp€«a€ate
Marne• Marne:
Address: Address:
State: City: State:
Zip: Phone: 1 Zip: Phone:
EEE SIMPLE TITLE HOLDEIL Not Applicable BONDING COMPAAM. _Not Applicable
Name: Name:
Address: Address:
ckr- may:
zip: Phone: Zip: Phone:
I certify that no work or Installation has commenced prior to the Issuance of a permi L
St Lucie Cous�tu makes no representation that is granting a pennrit will authorize the er<nIt I:o€demo build the subject structure
which is in co ct with any apprcable Home Owfiers Assoaation rales,bylaws or an�covenants that may restrict or prohibit such
structure.Please consult wig your Home Owners Association and review your deed for any restrictions Which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
ffracwrdancewith the aPpriiredplans,the FlandaBuilding Codes and et:LweCounty Amenrfroeetts
The following buffding.permit applications are exemptfrom undergoing a full concurrency review.room additions, r
accessory structures,swimming pools,fences,walls,signs.screen rooms and accessory,uses to another nen-residential use
WARNINGS TO OWNER:*Your failure to Record a Ince of Commencement may restiIt in your is y tg twke for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection.If you intend to obtain financing,consult with tender or an attorney before
comiftricingwork or recording your Notice of Comm ncernentri
s
_Signature of Owner/Lessee/Agent igna of Contractor/License Ho€der
srATE OF ILI�RI - .i}„ .A� STATE€3F FLOPJD
COB OFCOUMOF
Thef9ipinginstrum t acknowledged before m m TFie fo Ing In ent was acknowfedged b afore
Y � y 2_ this day 201.E_by
�r
za
a �-
� cnig f„K � vQc
game of P, n acknowledgingT k (Dame of Pers acMaowledging) W
c- -n2- ro a ?S
m.Nr 37 v.�Q C
a 7V y ZI
.s A
(Signature of NdLW Public-State of Fiddida) (Signature of Notary Public-State of Florida) � N
Personally Known OR Produced Identification Personally Known OR Produced leentrfrcation
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. - (Seal)
1
Revised 07115/2014
REVIEWS FRONT ZONING SUPERVISOR PIANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS